During a pickup basketball game one afternoon, Daniel — healthy, fit and in his mid-30s — heard his friend utter the words he would never forget. “Dude, what’s that black blotch on the back of your shoulder?” A few weeks later, Daniel was diagnosed with an aggressive form of skin cancer, malignant melanoma.
Through a surgical procedure known as Mohs’ micrographic surgery, his doctors removed the cancerous cells. But about two months later, he noticed a lump in his armpit — the cancer had spread to his lymph nodes. He underwent intensive chemotherapy, but his disease relentlessly progressed, spreading to his lungs. Daniel began interferon-alpha therapy, a treatment that boosts the body’s immune system response against tumors, but it made him so ill that after the first round he declined further treatment.
By the time I first saw Daniel, about a year after the diagnosis, the melanoma also had reached his liver, and he was declining fast. He had little appetite and had lost about 35 pounds. He could no longer work, let alone play basketball, and he relied on a cane just to walk. And now the cancer had spread to his bones, causing severe pain in his right hip. Realizing he might have only a few months to live, I gave Daniel a very short course of radiation therapy directed exclusively to his hip to relieve the pain. Like surgery, radiation therapy is a local therapy, meaning that (unlike chemotherapy and other systemic therapies) it generally affects only the irradiated area.
